Pittsburgh
Digestive Disorder Lawyer

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1. How does the Social Security Administration determine if I am disabled?
2. Eligibility
3. Applying for Disability Benefits

REVIEWED BY

C. William Kenny

December 12, 2023

Board certified by National Board of Trial Advocacy

How does the Social Security Administration determine if I am disabled?

Digestive disorders can make it impossible to hold a job. In some cases, people who are unable to work due to their digestive disorder might be entitled to Social Security disability benefits. For more information on recovering Social Security disability for a digestive disorder in Pittsburgh, call Berger and Green today: 412-661-1400.

Whether you are disabled hinges on the severity of your digestive disorder and whether it makes it impossible for you to work. To determine whether you are disabled, the Social Security Administration will assess your claim using one or both of the following methods:

Blue Book Evaluation

The SSA will evaluate your medical condition by referring to its Blue Book. This is a listing of impairments relating to various systems in the body. For the SSA to deem you disabled, you must meet the severity criteria under your specific listing. Digestive conditions are in Section 5.00.

The SSA breaks digestive disorders into six main categories:

Gastrointestinal hemorrhaging: You will need a minimum of three blood transfusions of at least two units, separated by 30 days, over the course of six months.

Inflammatory bowel disease (IBD): You must have had:

• Two hospitalizations in a six-month period because of an obstruction of stenotic areas due to your condition; or
• Two of the following: anemia, serum albumin, clinically documented tender abdominal mass with abdominal pain or cramping, perineal disease, involuntary weight loss, or a need for supplemental daily enteral nutrition.

You may also qualify under numerous other IBD-related conditions.

Liver transplants: The SSA classifies those who have received a liver transplant as disabled for a minimum of one year after the surgery.

Chronic liver disease: To qualify, you must have chronic liver disease with:

• Hemorrhaging that required hospitalization and a blood transfusion of two or more units; OR
• Ascites or hydrothorax not attributable to other causes documented by paracentesis or thoracentesis, appropriate medically acceptable imaging and one of the following: serum albumin or International Normalized Ratio of at least 1.5; OR
• Spontaneous bacterial peritonitis; OR
• Hepatorenal syndrome with one of the following: serum creatinine elevation of at least 2 mg/dL; oliguria; or sodium retention; OR
• Hepatopulmonary syndrome; OR
• Hepatic encephalopathy.

You may also receive benefits if your chronic liver disease is terminal, considerably affects your mental health or requires the use of shunts.

Short bowel syndrome: A surgeon must have removed over 50 percent of your small intestine for you to qualify.

Weight loss from digestive disorders: Your Body Mass Index (BMI) must be under 17.50 and you must follow all treatments properly to qualify for benefits.

If you do not meet the criteria under these listings, you might be able to meet the criteria under another listed condition.

The SSA also provides guidelines for evaluating various digestive disorders including:

• Hepatitis
• Kidney failure
• GERD
• Cirrhosis
• Gastroparesis

These disorders could all lead to complications and be accompanied by conditions affecting other parts of the body. If you have suffered a complication, you are more likely to qualify for disability benefits.

Non-Blue Book Conditions

Not all digestive ailments are in the Blue Book. If your condition does not fall under any of the digestive disorder categories, the SSA will have to evaluate your case using a different set of criteria. The SSA will ask the following questions when evaluating your case:

• What is the prognosis for your condition? If your digestive condition has lasted, or is expected to last, at least 12 months or result in death, the SSA will move on to the next question in the process.
• What is your current work status? To qualify, you need to earn less than the maximum amount allowed by the SSA.
• How severe is your medical condition? The SSA will consider whether your digestive disorder negatively and substantially impacts your ability to work. If your digestive disorder prevents you from doing basic work-related tasks (e.g., walking, standing, lifting light objects), the SSA will consider the following two questions.
• Are you able to work the same job you did in the past? If you are unable to work the job you did in the years before you became disabled, you may qualify for disability benefits, but only if you satisfy the last question.
• If not, can you work a new job? If you are unable to work a past job, the SSA will use your age, skill set, and other personal information to determine whether you will be able to take on a new type of job.

To determine whether you can work, the SSA will have you undergo a residual functional capacity (RFC) assessment. Determining your RFC will require the SSA to look at your day-to-day activities and figure out whether your digestive disorder will limit your ability to perform work-related tasks.

Eligibility

Even if your condition falls under a Blue Book listing, you will still need to show that you are eligible to receive benefits in the first place. First, you will need to establish that you are not working. If you are working, you will need to have earned less than $1,170 per month in 2017.

Next, you will need to qualify for disability benefits under the Social Security Disability Insurance (SSDI) or Supplemental Security Insurance (SSI) programs. The SSDI program converts earnings into work credits and determines if you have worked enough to qualify for SSDI. Your age will determine how many work credits you need to be eligible for benefits under SSDI.

To qualify for SSI, the number of work credits you have does not matter. You will just need to show that you have low income and less than $2,000 in assets for an individual.

If you have earned less than the maximum allowed and you are eligible for SSDI or SSI benefits, you should be able to receive benefits for a Blue Book listed condition.

Applying for Disability Benefits

To successfully apply for Social Security disability benefits, you will need to provide the SSA with information regarding your health. Providing detailed medical reports from your doctor, diagnostic test results, imaging results, and treatment plans can be very useful in building your case.

Applying for disability benefits is never easy, but an attorney can help make things a lot easier. The attorneys at Berger and Green are knowledgeable about how the SSA evaluates digestive disorder cases and will help make sure that you provide them with the information they need to rule in your favor.

And if your application receives a denial, we will be ready to file an appeal and go through the entire appeals process with you.

Call 412-661-1400 to schedule a free consultation with the attorneys at Berger and Green.